Facial Erythema and Edema in a Diabetic Man

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Abstract
REPORT OF A CASE A 37-year-old man with diabetes mellitus was admitted to the hospital because of diabetic ketoacidosis. At the time of admission, there was swelling of his right malar region thought to be secondary to an extraction of a right upper molar, which had taken place two weeks previously. On physical examination, the patient was febrile and dehydrated; his right cheek was erythematous and swollen (Fig 1), and discharge from his right nostril was also noted. Ophthalmologic findings included loss of vision in the right eye, right ophthalmoplegia, ptosis, and pupillary dilation. Funduscopic examination disclosed optic atrophy of the right eye. Laboratory findings were as follows: hemoglobin level, 12.0 g/dL; white blood cell count, 22,613/cu mm (with 87% neutrophils and 11% lymphocytes); and platelet count, 300,000/cu mm. His blood glucose level was 400 mg/dL; the serum urea nitrogen and creatinine levels were normal, with metabolic acidosis. Urinalysis revealed

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